Monday, October 05, 2015

Anti-Tobacco Groups Publicly Lie About the Effects of Low-Nicotine Cigarettes; Our Honesty is as Bad as the Tobacco Industry of Old

One of the core principles of public health is honesty. Our ethical code requires that we tell the truth to the public about potential health hazards. The ethical code goes even further by invoking the principle of transparency. Not only must we tell the truth, but we must tell the whole truth, so as not to mislead the public.

One thing that used to distinguish the anti-tobacco movement from the tobacco industry is that we always told the truth while the industry often lied. Unfortunately, and ironically, the tables have now turned.

Sadly (but not surprisingly to me at this point), several anti-tobacco groups are lying to the public by informing them that a new study, published last week in the New England Journal of Medicine, showed that low-nicotine cigarettes helped smokers quit.

The groups lying to the public are:

the Campaign for Tobacco-Free Kids;

the American Legacy Foundation; and

the Center for Tobacco Control Research & Education at UCSF.

According to the Campaign for Tobacco-Free Kids: "This study indicates that by significantly reducing the nicotine content of cigarettes, it is possible to reduce the addictiveness of cigarettes to help more smokers quit."

According to the American Legacy Foundation, this new study shows that: "low nicotine products can reduce addictiveness and lead to quitting. ..."

According to Dr. Stan Glantz of the Center for Tobacco Control Research & Education at UCSF, the new study "shows smokers smoke less and quit more after big cuts in nicotine in cigarettes."

The Rest of the Story

The rest of the story, quite simply, is that all three of these groups are lying to you.

The study measured the likelihood of subjects continuing to smoke at 30-day follow-up for each of the assigned study groups. By comparing the differences in the likelihood of quitting, the study was able to determine whether subjects in the low-nicotine group were more or less likely to quit smoking compared to the high nicotine groups (see Table S-10).

According to the table, in adjusted logistic regression models, compared to smokers who were assigned to smoke their usual brand of cigarettes, smokers in the low-nicotine (0.4 mg) group were equally likely to have quit at 30-day follow-up. Specifically, there was no statistically significant difference in the proportion of quitters between the low-nicotine cigarette smokers and the usual brand smokers.

Thus, these data do not indicate that smokers in the low-nicotine group were more likely to have quit smoking than those continued to smoke their brand as usual. In other words, this study failed to find that low-nicotine cigarettes had any significant effect in terms of helping smokers to quit.

Thus, by claiming that the study found that low nicotine cigarettes led to more quitting, all three of the above anti-tobacco groups are misrepresenting the study findings and lying to the public about the true reported results of the study.

Furthermore, as I discussed last week, the study did not even find that the smokers of low-nicotine cigarettes cut down on the amount they smoked. In fact, there was no change in cigarette consumption among the low-nicotine smokers from baseline to six-week follow-up. Thus, the conclusion that smokers who switched to low nicotine cigarettes reduced their consumption is also unsupported.

Finally, the study found no significant improvement in self-reported respiratory health among low nicotine smokers (see Tables S-40 to S-44) and no significant improvement in overall self-reported health (Table S-45).

The bottom line is that this study produced no evidence that low-nicotine cigarettes had any significant positive effects in terms of reducing cigarette consumption, quitting smoking, or improving health.

Even the reported finding in the paper that smokers of the low nicotine cigarettes were twice as likely to attempt to quit is highly misleading. The quit attempt proportions are only significantly different if you compare the low-nicotine group to the 15.8 mg group. But if you compare the low-nicotine group to the usual brand group (which, to me, is the most appropriate comparison), there was no significant difference in the proportion of subjects who attempted to quit smoking (Table S-12). This is an important finding which all three of the anti-tobacco groups fail to disclose to the public.

What the anti-tobacco groups are doing is really no different than what tobacco companies used to do in their public communications. Lying is lying, and it isn't justified when anti-tobacco groups are doing it but unjustified when tobacco companies are doing it. For a movement which has spent so much time and effort criticizing the tobacco industry for lying to the public, it seems wholly unacceptable that we are now doing the same thing.

While I am not comparing the damage done by the tobacco industry's lies in the past to the damage being done by the anti-tobacco movement's lies, it is important to point out that there is still damage being done. If the lies being disseminated about low nicotine cigarettes end up affecting public policy, they could do real damage by promoting a policy that could end up being ineffective.

It is becoming clear to me that the public can no longer rely on anti-tobacco organizations to receive accurate scientific information about tobacco products. Ironically, they are presently getting more reliable information from the tobacco companies. This is a sad, but true state of affairs.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.